A procedure was introduced for determining the thickness of the articular cartilage of the patella. The results revealed that the cratilage was thicker at the site of contact between the patella and the femur than in other parts. CT and X-ray images were used to investigate movement of the patella from full extension to full flexion of the knee joint. As the flexion increased, the patella prorated, i, e., the site of contact with the epicondyle and condyle of the femur shifted from the lateral to the medial facet of the articular face, as deduced from the decrease in the bicondylo-patellar angle. Vertically, the patella moved from the epicondyle to the condyle level, but the distance between the apex of the patella and the tuberosity of the tibia remained almost unchanged. Serial slices (5 mm thick) of a plaster replica of the patella cut at right angles to the central ridge showed a change in the angle between the two facets of the articular face from the proximal to the distal side. The same results were obtained with CT slices. These findings suggest that adequate pressure stimulates development of the cartilage and that CT is a good method for studying movement of the patella.

Purpose: We evaluated the efficacy of continuous administration of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) in patients with end-stage non-small cell lung cancer. Method: Our study included 33 patients most recently treated with EGFR-TKI for non-small cell lung cancer that had once been responsive to EGFR-TKI but eventually showed worsening. We compared patients who discontinued EGFR-TKI within one month (n=16) after their disease progressed and those who continued the treatment (n=17). Results: The median survival time was significantly longer in patients who continued EGFR-TKI (191 days) than in those who discontinued the treatment (62 days) (p=0.0098). Adverse events experienced by patients who continued the treatment included Grade 1 eruption in six, Grade 2 eruption in one, Grade 1 diarrhea in one and Grade 1 AST/ALT elevation in four. All of these adverse events were manageable. Conclusion: In patients with non-small cell lung cancer initially responsive to EGFR-TKI but eventually showing worsening and becoming unfit for cytotoxic anticancer drugs, continuous administration of EGFR-TKI may extend their survival with acceptable toxicity. Further investigation of this strategy is warranted. Palliat Care Res 2011; 6(1): 119-125

The effects of bathing with inorganic salts and carbon dioxide (ISCD) on body temperature, systemic circulation, food ingestion and absorption have been studied in healthy volunteers. The peripheral blood flow in the forearm was found to increase in and after immersion of the forearm into a 25l bathing receptacle containing ISCD, as compared with plain water. The peripheral blood flow tended to increase in a dose-dependent manner with ISCD bathing. The skin core temperature, the skin surface temperature and the peripheral blood flow were significantly higher after ISCD bathing than after plain water bathing. The influences of ISCD bathing on food ingestion and absorption were also studied in healthy volunteers. Blood glucose and insulin levels after food ingestion tended to be suppressed by ISCD bathing as compared with plain water bathing. There was no difference between ISCD and plain water bathing in total protein, total cholesterol, triglyceride, HDL cholesterol, and uric acid levels in the blood. These results suggest that ISCD bathing may contribute to the promotion of human health.

Background: The demand for palliative care in Japan has risen over recent years, and training of palliative care physicians is an important problem. However, little is known about unmet needs for education and training systems as well as career development among young physicians who wish to specialize in palliative care. Purpose: To explore unmet needs among palliative care physicians in training. Method: We held group discussions in a forum for physicians of postgraduate year≦15, and analyzed their opinion on topics such as "what are unmet needs?" using theme analysis. Results: Forty physicians participated. Theme analysis revealed the following unmet needs among young physicians; "securing of manpower", "securing of quality of training programs/education", "improvement of network", "removal of many barriers to keeping on a palliative care physician", and "establishment of career models for a specialist". Conclusions: We should discuss solutions for the unmet needs to secure more palliative care physicians.

Objective: In this study, we surveyed the attitudes of community pharmacists regarding oral antidiabetic drugs that need to be continuously administered, focusing especially on recently available oral‐combination antidiabetic drugs, in terms of their positioning and medication adherence.　In addition, we identified relevant problems from the survey results and discussed the proper use of the combination drugs.Methods: We conducted a questionnaire‐based survey on health insurance‐covered dispensing pharmacies belonging to Kanazawa, Koga, Takasaki, Hitachi, and Hitachinaka Pharmaceutical Associations via fax or post from September 1, 2017 to November 30, 2017.Results: The overall response rate to the survey was 29.8%.　Although combination drugs were considered useful in terms of improved motivation to take medication, i.e., medication adherence, there were also opinions claiming that combination drugs are not particularly useful due to the following reasons: there are problems in discarding residual drugs, they are less economical than individual drugs, it is difficult to ingest tablets of combination drugs because of their large size, it is difficult to adjust doses of combination drugs, and medication adherence does not change because of concomitant drug use.Conclusion: Based on the results there was the opinion that a combination oral diabetes drug improves medication adherence but problems such as the generation of leftover unused drugs due to switching and an increase in the risk of overuse when taking medication was pointed out.　It is necessary for pharmacists to give advice in recognition of the risks with each active ingredient of the oral diabetes combination drug and to continuously monitor any development of side effects.　Furthermore, as with other diabetes remedies, pharmacists need to advise regarding the patient's lifestyle as well as monitor laboratory test results such as kidney function.　The patient's swallowing ability is also an important consideration at the time of medication instruction.

Objectives: “Adverse Drug Reaction Relief System” (hereinafter called the Relief System) has been established to provide prompt relief to patients experiencing health damage caused by adverse drug reactions. Since 2018, the Relief System has required community pharmacies that acquire additional points as local support system to actively report adverse drug reactions. Here, we investigated the recognition and utilization of the relief system among community pharmacists.Method: A questionnaire survey was conducted among community pharmacists between August 1 and September 30, 2019.Results: The survey achieved a response rate of 58.1%. The recognition rates of the relief system and Pharmaceuticals and Medical Devices Agency (PMDA) as its application destination were 98.9 and 74.5%, respectively. Of the community pharmacists, 2.6% had experience in utilizing the relief system; and 8.8% did not want to recommend the utilization of the relief system for patients mainly because of the “low recognition of the system” and “the complicated and troublesome preparation of the necessary documents such as medical certificates.” The community pharmacists who acquire additional points as local support system, compared with those who do not, achieved significantly higher rates in two items, including that for preparation of the documented procedures pertaining to adverse drug reactions.Conclusion: Despite the high recognition of the relief system among community pharmacists, the percentage of pharmacists with experience in actually utilizing the relief system and applying to the PMDA was low. One reason that the use of the relief system was not widespread was the low recognition particularly of the destination and procedures of reports on adverse drug reactions. In the future, educational campaigns to improve pharmacists’ comprehension of the relief system will be needed. Moreover, pharmacists must play a central role in enhancing the recognition of the public relief system and promoting medical safety.

Objectives: To explore background factors contributing to learning needs among physicians in palliative care specialty training. Methods: We conducted a questionnaire survey of physicians in specialty training in palliative care who were within 15 years after medical school graduation. The unmet learning needs (referred to as “needs”) were evaluated on a 5-point scale. Factor analysis was performed to identify underlying subscales of needs. Univariate analysis was performed using an average score of each subscale as a dependent variable and background factors as independent variables. Results: Of 284 physicians, 253 (89%) responded, and 229 were eligible after we had excluded resident physicians with less than 2 years of clinical experience and board-certified palliative care physicians. Factor analysis identified six subscales of the unmet learning needs: research, time, specialist, network, quality, and comprehensiveness. Background factors with significant between-group differences with the effect size of 0.4 or more included: 1) not working at a certified training facility, 2) not working or training at a big hospital, and 3) the number of palliative care physicians being 2 or less in the facility. Conclusion: Improvement of the training system is urgently needed for young physicians who are working at small or non-certified facilities for specialty training, or who have few palliative care colleagues.

Training system of palliative care in Japan has not been fully established, and young physicians’ needs for palliative care training are not nearly satisfied. We have recently conducted a nationwide survey to clarify unmet learning needs among Japanese physicians in specialty training in palliative care and the potential solutions they favored to meet those needs. Here we report findings of content analyses of free comments in the survey. Of 284 physicians, 253 (89%) responded, and 229 were eligible after we had excluded resident physicians with less than 2 years of clinical experience and board-certified palliative care physicians. The content analyses from 80 physicians (35%) identified 162 codes with respect to needs for improvement which were further classified into 24 subcategories and 9 categories (e.g., contents of subspecialty training, certified facilities, research capabilities, learning environment and methods, system of board certification, and networking). These findings may help improve specialty training in palliative care in Japan.

Background: Bathing is an important behavior for keeping the body clean and is one of the habits of daily life. Among other things, bathing is regarded as a means of relieving fatigue, refreshing oneself, benefiting health, and improving sleep. As such it can be considered a health-maintaining activity. Apart from a previous study by the authors, there has been very little research on the relationship between home bathing habits and health. Objective: The aim of this study was, therefore, to clarify how physical and mental health relate to daily bathing in the home, particularly the habit of full bath immersion. Method: The participants were 198 employees of a quasi-drug manufacturing company and their family members who could and cooperated in the present study. The study was conducted as a self-report survey from October 1-30, 2010, with questionnaires being distributed to and collected from subjects before and after this period. Participants were asked about their sex, age, frequency of bathing per week, frequency of use of bath additives per week, temperature of bath water, bathing duration, and water level when in the bath, health, and sleep quality. Health was assessed using the Profile of Mood States (POMS) inventory, and self-rated health and quality of sleep were assessed using a Visual Analog Scale (VAS). Results: Among bathing habits, the group with a high bath frequency had significantly low scores for tension-anxiety and depression-dejection mood scales, and significantly high self-rated health. In the present study, self-rated health and quality of sleep were significantly better in the group who frequently used bath additives. In the full bath group, Fatigue score was significantly low and self-rated health and quality of sleep scores were significantly high. Discussion and Conclusion: Taking a full bath frequently and frequent use of bath additives are bathing habits that increase physical and psychological health in the middle-aged.